Helping to Prevent Diagnostic Error

By: Clare Thornton, HTL (ASCP), QIHC (ASCP)

Published December 4, 2018

On November 7, 2018, I attended a meeting of the Clinical Laboratory Improvement Advisory Committee (CLIAC) on behalf of NSH. I had the opportunity to hear two presentations on diagnostic error. CLIAC is concerned about diagnostic errors, and asked the presenters to speak on the following question: What are practical ways in which the CDC, CMS, and the FDA can support team-based diagnostic decision making that includes laboratory professionals as part of the team?

The first speaker was Dr. Michael Laposata, and he presented the findings of the Institute of Medicine’s Committee on Diagnostic Error. The findings were astounding!

According to a survey presented by the CDC, medical error is the third leading cause of death in the US (medical error being defined as all medical errors, both treatment related and diagnostic).

Diagnostic error is defined as the failure to (a) establish an accurate and timely explanation of the patient’s health problems, or (b) communicate that explanation to the patient. The committee determined that the broken piece is the failure to build diagnostic teams of health professionals.

This is where we, as histology professionals, need to be: a part of the diagnostic team of health professionals. If we do not do our job well, then the pathologists that we serve cannot do their job well. Every day, as histotechs, we take our patients lives into our hands.

What Can We as Histologists Do?

NSH, in its letter to CMS, which I presented at the CLIAC meeting, urges that the CLIA recommendations be amended to include histotechnicians and histotechnologists under CLIA’s oversight. As I shared in a previous blog post this month, histology is not considered testing, and is therefore not regulated under CLIA. In addition, NSH is proposing that histotechnicians and histotechnologists be required to pass an accredited certification examination for laboratory personnel performing pre-examination through post-examination processes in histopathology laboratories. To prevent the requirement from becoming onerous, and to address workforce shortage concerns, NSH proposes that on the job trained non-certified technicians with at least five years’ experience in a CLIA certified laboratory at the time that the new regulations go into effect, be given five years to continue to work and obtain the required high complexity certification. During this five-year transition period un-certified techs must work under the direct supervision of a certified technician.

NSH is hopeful to continue working directly with CLIAC in order to advance our profession, and to be viewed as the professionals that we are. In what other healthcare industry are workers allowed to deal so closely with patient diagnoses and not be certified? Hair stylists need to be certified to cut and color people’s hair. We should be certified to cut and color patients’ biopsies.

Dr. Laposata, in his presentation on diagnostic error, said that teams of health professionals are necessary to prevent medical errors. Histotechnicians and histotechnologists must be a part of that team.
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